What does 'Brexit' mean for the UK's healthcare landscape?

In the Referendum debate, the NHS featured prominently, but mostly as the potential beneficiary of more taxpayer funding, either as a 'Brexit bonus' when UK contributions to the EU go down, or as a result of stronger economic growth.

The Brexit bonus will have to happen, by 2019-20. But for health and life sciences, the implications of Brexit go much wider.

The primary concern is with staffing and skills. Presently more than 10,000 doctors, over 20,000 nurses, and some 90,000 care workers are EU workers residing in the UK. Not only do we need to keep them, but we may need even more. A system of accrued rights, and at the least a permissive regime for recruiting shortage occupations, will be needed, even if the reduction in migration into Britain is not what some 'Leave' voters wanted.

The systems for mutual recognition of qualifications, of reciprocal access to healthcare and EHIC all are clearly of mutual benefit and it would be technically possible to agree continuing arrangements between Britain and EEA countries. But does the British Government want to pay the several hundreds of millions the reciprocal healthcare costs? Can it justify offering the EHIC in Europe but not to other countries (noting however that Canada and Australia have similar such agreements with Britain)?

Similarly, it would surely be technically soluble to maintain UK participation in the European research community, and compliance with the Clinical Trials Regulations, but is the British government willing to pay the necessary contributions and accept EU decisions? And in respect of regulatory processes for Pharma and for medical devices, the UK's MHRA is a world-leader, but are EU countries willing to enable regulatory equivalence to be operated as a two-way street, exploiting the British regulators' expertise to be deployed to the benefit of Europe?

That points to the essence of our current problem. We can see the many practical issues, we can probably find practical solutions to them and, with goodwill on both sides, make it work.  But that is before the politics of the overall negotiations kick in. At what point does the British Government say "no" to more budget contributions? Where does it draw the line on work permits? How does it create a dispute resolution system which isn't the ECJ in disguise? How willing is it to accept that 'regulatory equivalence' is EU regulatory control in reality?

And, for the EU member-states, where do they draw the line on the British having slices of the EU cake while keeping their red, white and blue Victoria sponge to themselves? How much of a 'pound of flesh' will they need to cut from UK participation in mutually beneficial programmes and systems, in order to deter anyone else from contemplating the Article 50 route?

These are the questions that have to be answered during the Article 50 negotiations and, until they are, we can put the practical and transitional arrangements in place to support health and life science cooperation, but we will not be able to determine the final relationship. That uncertainty is a burden we have to live with for months yet, possibly down to the wire on Article 50.